ABSTRACT
INTRODUCTION: Near-infrared imaging may facilitate intraoperative identification of parathyroid glands by causing autofluorescence but its clinical value has not been established. Inadvertent parathyroidectomy occurs in 5-22% of thyroidectomies and is associated with temporary and permanent hypoparathyroidism. The aim of this study was to determine whether near-infrared imaging prevents inadvertent parathyroidectomy and early hypocalcaemia as a surrogate for permanent hypoparathyroidism. MATERIALS AND METHODS: Near-infrared imaging was used in a prospective cohort of consecutive thyroidectomies. Thyroidectomies performed prior to the introduction of near-infrared imaging formed a control group. The thyroid bed and specimen were scanned with near-infrared imaging. Areas of autofluorescence on the specimen were examined and any parathyroid tissue found was autotransplanted. Inadvertent parathyroidectomy was therefore recorded as established intraoperatively by near-infrared imaging (allowing autotransplantation) or on subsequent histology (missed). Serum calcium and parathyroid hormone were measured on day one and at two weeks and six months postoperatively. RESULTS: A total of 269 patients were included: 106 near-infrared imaging and 163 controls. Inadvertent parathyroidectomy was detected by near-infrared imaging in two (and autotransplantation performed) and histologically (i.e. missed by near-infrared imaging in 13, 12.3% vs 17, 10.4% controls). Neither result was statistically significant (P = 0.08, 0.89). There was no significant difference in serum calcium or parathyroid hormone between near-infrared imaging and control groups at one day, two weeks or thereafter. DISCUSSION: Near-infrared imaging may detect inadvertent parathyroidectomy and may allow autotransplantation. It did not, however, reduce the incidence of missed inadvertent parathyroidectomy and no difference was seen in early hypocalcaemia or late hypoparathyroidism. Current near-infrared imaging technology does not appear to confer a clinical benefit sufficient to justify its use.
Subject(s)
Hypocalcemia/prevention & control , Hypoparathyroidism/prevention & control , Intraoperative Complications/prevention & control , Optical Imaging/methods , Parathyroid Glands/diagnostic imaging , Thyroidectomy/adverse effects , Adult , Feasibility Studies , Female , Fluoroscopy , Humans , Hypocalcemia/epidemiology , Hypocalcemia/etiology , Hypoparathyroidism/epidemiology , Hypoparathyroidism/etiology , Incidence , Intraoperative Complications/epidemiology , Intraoperative Complications/etiology , Male , Middle Aged , Parathyroid Glands/injuries , Parathyroid Glands/transplantation , Prospective Studies , Thyroid Gland/surgery , Transplantation, AutologousABSTRACT
Trisomy for the distal part of the long arm of chromosome 8(q24.13----qter) is described in three sibs. The anomaly arose as an adjacent 1 meiotic segregation from a balanced reciprocal translocation t(1;8)(q44; q24.13)mat.
Subject(s)
Chromosomes, Human, Pair 8 , Trisomy , Adult , Child , Child, Preschool , Face/abnormalities , Female , Fingers/abnormalities , Humans , Infant, Newborn , Intellectual Disability/complications , Intellectual Disability/genetics , Male , Pedigree , Toes/abnormalitiesABSTRACT
Two infants with meningitis who were treated with phenobarbitone and high-dose chloramphenicol showed progressive falls in the peak blood levels of chloramphenicol. A standard chloramphenicol dose of 50 mg/kg daily would have produced subtherapeutic blood levels after only a few days. The importance of measuring serial blood chloramphenicol concentrations is stressed.
